Provider Demographics
NPI:1194961748
Name:MIRACLE LIFE HOME HEALTH INC
Entity type:Organization
Organization Name:MIRACLE LIFE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:GYURDZHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-785-3387
Mailing Address - Street 1:14416 VICTORY BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1441
Mailing Address - Country:US
Mailing Address - Phone:818-785-3387
Mailing Address - Fax:
Practice Address - Street 1:14416 VICTORY BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1441
Practice Address - Country:US
Practice Address - Phone:818-785-3387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-04
Last Update Date:2009-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health